Changes in outpatient antibiotic prescribing for acute respiratory illnesses, 2011 to 2018

Abstract

Objectives: To describe acute respiratory illnesses (ARI) visits and antibiotic prescriptions in 2011 and 2018 across outpatient settings to evaluate progress in reducing unnecessary antibiotic prescribing for ARIs. Design: Cross-sectional study. Setting and patients: Outpatient medical and pharmacy claims captured in the IBM MarketScan commercial database, a national convenience sample of privately insured individuals aged <65 years. Methods: We calculated the annual number of ARI visits and visits with oral antibiotic prescriptions per 1,000 enrollees overall and by age category, sex, and setting in 2011 and 2018. We compared these and calculated prevalence rate ratios (PRRs). We adapted existing tiered-diagnosis methodology for International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. Results: In our study population, there were 829 ARI visits per 1,000 enrollees in 2011 compared with 760 ARI visits per 1,000 enrollees in 2018. In 2011, 39.3% of ARI visits were associated with ≥1 oral antibiotic prescription versus 36.2% in 2018. In 2018 compared with 2011, overall ARI visits decreased 8% (PRR, 0.92; 99.99% confidence interval [CI], 0.92–0.92), whereas visits with antibiotic prescriptions decreased 16% (PRR, 0.84; 99.99% CI, 0.84–0.85). Visits for antibiotic-inappropriate ARIs decreased by 9% (PRR, 0.91; 99.99% CI, 0.91–0.92), and visits with antibiotic prescriptions for these conditions decreased by 32% (PRR, 0.68; 99.99% CI, 0.67–0.68) from 2011 to 2018. Conclusions: Both the rate of antibiotic prescriptions per 1,000 enrollees and the percentage of visits with antibiotic prescriptions decreased modestly from 2011 to 2018 in our study population. These decreases were greatest for antibiotic-inappropriate ARIs; however, additional reductions in inappropriate antibiotic prescribing are needed.

Antibiotic Prescriptions Associated With COVID-19 Outpatient Visits Among Medicare Beneficiaries, April 2020 to April 2021

“…To identify visits with a primary diagnosis of COVID-19, we first limited them to those with International Classification of Diseases and Related Health Problems, 10th Revision diagnosis code U07.1. We then excluded visits with additional diagnosis codes for conditions for which antibiotics are always or sometimes appropriate based on clinical guidelines using a previously described tiered system . Visits were then linked to an antibiotic if prescribed within 7 days before or after the visit.…”

“…We then excluded visits with additional diagnosis codes for conditions for which antibiotics are always or sometimes appropriate based on clinical guidelines using a previously described tiered system. 2 Visits were then linked to an antibiotic if prescribed within 7 days before or after the visit. We reported visits by setting and month, including antibiotic classes.…”

Regional Variation in Outpatient Antibiotic Prescribing for Acute Respiratory Tract Infections in a Commercially Insured Population, United States, 2017

“…Visits were assigned a single diagnosis based on a previously described 3-tiered system that categorizes conditions based on whether antibiotics are always (Tier 1), sometimes (Tier 2), or rarely indicated (Tier 3) [ 1 ], adapted for ICD-10 codes [ 18 ]. We limited our analysis to visits with common ARTI diagnoses (pneumonia, pharyngitis, sinusitis, acute otitis media, acute exacerbation of bronchitis, asthma/allergy, bronchitis/bronchiolitis, influenza, nonsuppurative otitis media, and viral upper respiratory infection) ( Supplementary Table 1 ).…”

Nasopharyngeal rapid diagnostic testing to reduce unnecessary antibiotic use and individualize management of acute otitis media

“…Associated organism Kaur et al 7 Kaur et al 26 Yatsyshina et al 27 Wald et al 29 Casey et al 55 Frost et al 56 Bacterial pathogen detected a 0.88 0.8 32 Mas-Dalmau et al 34 McCormick et al 35 Siegel et al 36 Spurling et al Hoberman et al 38 Amoxicillin failure 0.037 0.017 0.055 Gerber et al 9 Frost et al 57 Broad-spectrum antibiotic failure 0.046 0.046 0.1129 Gerber et al 9 Frost et al 56 Frost et al 57 Adverse drug events and complications AOM on a national scale. 23 For other infections, such as pharyngitis, the use of rapid diagnostic tests (RDTs) has significantly reduced unnecessary antibiotic use as has individualized care based on the organism(s) detected. 24,25 An RDT for AOM could prevent unnecessary antibiotic use for children while assuring that children likely to benefit from an antibiotic receive one.…”